FORM RE - 1

(See rule 112 of the Explosives Rules, 2008)

Application for Renewal or revalidation of licence or certificate
(See also note below before filling up the form)
Form : ------------------------------------------------------------------------To,
____________________
____________________
Dear Sir,
1. I,.. on behalf of apply for renewal of licence or certificate
number.................
inform..for the period from ..to and furnish the following
information :
During the last five years
(i) I was/we were
(a) not convicted/convicted and sentenced for..for following offences..
(b) not ordered/ordered to execute under Chapter VIII of Code of Criminal Procedure, 1973, a bond for keeping
peace or for good behaviour.
(c) Not issued any direction from the Court in connection with the above said licence or certificate.
( Give details if answer in affirmative)
(ii) Licence or certificate No..in Form..granted under the Act and these rules to me/us
were
cancelled/not renewed by the licensing authority.
2. I/We also enclose the following documents:
(i) Licence or certificate No..in Formtogether with approved plans and schedules.
(ii) Renewal fee of Rsby bank draft of(name of issuing bank) bearing number date
.payable
in favour of
3. I/We confirm that I/we shall inform you about the court's order or direction, interim or otherwise, if any
issued in
connection to the licence for which renewal is being applied, failing which I/we shall commit a punishable
offence.
4. I/We hereby certify that
(i) the above particulars given by me/us are correct.
(ii) I am/we are aware that if explosives are illegally transferred by me/us to any unauthorised person(s), I/we
shall
commit a punishable offence.
(iii) I am/we are aware that if I/we conceal any material information relevant to this application, I/we shall
commit a
punishable offence and in addition, any administrative action can be taken against me/us.
Signature of Licensee or certificate holder ............
(Authorised person in case of company)
Place Date of application..